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Duration of Treatment After Eye Involvement in Giant Cell Arteritis

To the Editor:

Patients and physicians would like to know the duration of treatment required for giant cell arteritis (GCA). It is not always possible to accurately estimate how long treatment will be required. There is some histopathological evidence that the presence of eye manifestations in GCA is associated with more advanced disease¹. Loss of vision in GCA may be due to ischemic optic neuropathy, central retinal artery occlusion, choroidal ischemia, or stroke. Other ophthalmic complications include double vision with extraocular muscle ischemia, ischemic ocular motor nerve palsy, ocular ischemic syndrome, hypotony, and Horner's syndrome^2-4.

We investigated whether the presence of eye involvement significantly lengthens the duration of steroid therapy. We conducted a retrospective study of 30 patients with biopsy-proven GCA between 1995 and 2004 at Southend University Hospital. We compared the duration of treatment for patients with and without eye involvement. The study was approved by South Essex Research Ethics Committee.

All patients followed the same treatment protocol; however, individual patient regimes were formulated depending on clinical presentation, severity of symptoms, patient response to treatment, and the development of side effects. An initial single daily dose of 40–80 mg prednisolone was given for 2 to 4 weeks, then gradually reduced every 2 to 4 weeks by no more than 10% of the total daily dose. Regular assessment of clinical symptoms, erythrocyte sedimentation rate, and C-reactive protein was used to monitor the patient response. Once patients were taking a lower dose of prednisolone, monitoring was reduced to every 6 to 8 weeks and the prednisolone was tapered toward the lowest required dose or stopped. In addition, all patients received calcium and vitamin D supplements.

Of 30 patients with GCA, 16 patients had serious eye involvement. Of these, 15 had anterior ischemic optic neuropathy and one patient had a fourth cranial nerve palsy. The mean duration of treatment in patients with eye involvement (25.69 mo ± 12.80) was significantly longer than in those without eye involvement (11.2 mo ± 3.25; T test p = 0.0018; Table 1).

Table 1. Demographic characteristics of patients with giant cell arteritis.

It is probable that the presence of eye involvement in GCA determined the need for longer corticosteroid therapy. In practice, a physician can better estimate the length of treatment period required depending on the presence or absence of eye involvement.

Larger studies could better show the exact value of this prediction.

KAYVAN ARASHVAND, MD, MRCOphth, Senior House Officer in Ophthalmology; WILLIAM LESLIE ALEXANDER, FRCS, FRCOphth, Consultant Ophthalmic Surgeon, Eye Unit; BHASKAR DASGUPTA, MD, FRCP, Consultant Rheumatologist, Honorary Professor, Department of Rheumatology, Southend University Hospital NHS Foundation Trust, Prittlewell Chase, Westcliff-on-Sea, Essex, United Kingdom, SS0 0RY. Address reprint requests to Dr. Arashvand. E-mail: k_arashvand@yahoo.com

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